a medical librarian's adventures in evidence-based living

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I was lucky enough to get my "gate-keeper" physician to write an order for a new lipid panel, but since I know I probably won't be able to have another one taken for five more years, I want to make sure that this one will accurately reflect my diet changes. If I were on statins, they'd want to check me every year.

So, after talking to Dr. Esselstyn, I decided to wait one more week to have my blood work taken. And frankly I'm not in any hurry, because I'm now so used to this eating style that I'm finding it easier & easier to do, not to mention, delicious.

It's Not A Numbers Game - It's All About What You're Eating

Yesterday I also had a chance to ask Dr. Esselstyn a few of the questions that readers have been asking me.

So what if my numbers don't go as low as I'm hoping they'll go?

Dr. Esselstyn stressed that the health of my blood vessels is dependent upon what I'm eating--in spite of the numbers. If I'm really eating 100% plant-based, no-oil, all whole grain, very heavy on the greens, beans, fruits, & legumes--no problem! He says my blood vessels should be thanking me by now.

Turns out, even the Tarahumara Indians, who had no heart disease to speak of--had LDL levels from 80-115--and some had HDLs as low as 26--the kind of numbers that might make a cardiologist pull out a prescription pad. They were eating only beans, squash, & sweet potatoes--not a bit of oil. Their LDLs were the light fluffy kind and they weren't causing a bit of damage. And their lower HDLs weren't a problem either, because the Tarahumara's weren't eating anything that was going to turn their LDLs into the small dense dangerous bad guys. If you aren't eating any inflammatory endothelial-damaging foods like fats, oils, and animal products---and you're loading up on high anti-oxidant greens you've reached the most important goal of all! Your numbers will probably reflect this--but don't worry if they don't.

Number One Reader Question. My Cholesterol is Just Fine. My Weight's Fine, I Exercise, and I Eat a Healthy Mediterranean Diet. Why in the World Would I Need to Eat This Way?

Short Answer from Dr. Esselstyn: Unless you are one of the lucky few and none of your relatives have ever had vascular disease and they all lived to be a healthy 100, then you more than likely already have some degree of vascular disease. Unless, of course you've been eating like the Papua New Guinea Highlanders or the Tarahumara Indians all your life.

There are countless autopsy studies (click here for a few) of young adults from age 15-34 showing that everyone who eats our Western diet has heart disease. It's a given.

If you eat a healthier Mediterranean diet with olive oil, fish & chicken you're better off than someone who is eating cheeseburgers & fries--and you may be able to put off the likelihood of getting those nasty imperceptible tiny strokes (Dr. Megan Cleary of California examined over 11,000 MRIs of the brains
of 50 year olds & found many had tiny white spots that indicated
that they had unknowingly experienced tiny, imperceptible strokes.
These "brain attacks" have the same history and cause as heart attacks), heart disease or vascular problems until your mid-70s or 80s--but just think about spending your last years in a wheelchair, immobile, befuddled, and mute--or think about the erectile dysfunction, slowed mobility, balance and cognitive problems that are all caused by impaired circulation and could be prevented.

And then there's a whole host of other problems, like diabetes, hypertension, arthritis, constipation, and some cancers that could be avoided if you changed your diet. Not to mention the side effects to all the medications you'll likely end up taking to keep heart disease, diabetes, hypertension, aortic valve stenosis, and erectile dysfunction at bay. Diet can do a much better job.

Consider the email I received from a reader who thought he was doing everything right. And then read about middle-aged fitness cyclist Michael Bicks who also thought he was doing everything right. "Not a Moment Too Soon I Thought of Tim Russert" click here."

Dear Dr.Esselstyn,I'm writing at the suggestion of "The Healthy Librarian" who told you about
my success with your diet (I've enjoyed the Engine 2 Diet as well).

As I mentioned to her, in August 2007 I had quadruple
bypass surgery. I was actually fortunate. I'd had no symptoms (apart
from an unusual sensation in my chest when I
exercised), "normal" cholesterol (180-200), and no real family history. I
was not overweight and had long eaten a low- to non-fat diet.

When I left
the hospital, which is affiliated with a prominent medical school, they told me
didn't need to change my diet in any way. In addition to my PCP, I see an
expert in the treatment of cholesterol. She's told me that she can't
explain why I developed heart disease.

Since my surgery, I've followed your diet
fairly rigorously. In March my scores were total cholesterol of 64, triglycerides 29, HDL 32 and LDL 26. Needless
to say, I am gratified and relieved.

In addition to the diet, I had
been taking 40 mg/day of Lipitor; since March that has been reduced to 20
mg/day. I also take 1000 mg of Niaspan/day.

I realize these
medications likely played some role in my low scores; however, since
not everyone who takes them does so well, I assume my diet is the major
factor.

My only vice is avocado once or twice/week and
low-non-fat dark chocolate (cocoa) powder in my coffee
every day. And I feel great!!

Me: Here's what Dr. Robert Vogel has to say about the Mediterranean diet.

"The
beneficial components...appear to be anti-oxidant rich foods, including
vegetables, fruits, and their derivatives. Dietary fruits, vegetables
and their products appear to provide some protection against the direct
impairment of endothelial functions produced by high-fat foods,
including olive oil." (Vogel study: a meal containing olive oil impairs
blood flow & vasodilation by 31%--and that was in healthy men)

Number Two Reader Question. I thought we needed oil to absorb fat soluble vitamins, like vitamin A. How am I going to absorb them on a fat-free diet?

Esselstyn: Why would you want eat your vegetables with blood vessel-damaging oil? Besides, this isn't a fat-free diet. It's a no-oil added diet. All food has some amount of fat in them. The Iowa State University study on vitamin absorption with full-fat salad dressing was sponsored by Proctor & Gamble. Follow the money trail. It's in their best interests if we continue to eat oil. And besides, you rarely eat foods in isolation--there is always going to be some naturally occurring fat in your whole-grain pasta noodles, or beans--and whatever else you are eating with your vegetables.

My brilliant observation: Since I've been analyzing some of my daily food intake on "My Food Diary" I consistently notice that I am getting over 2000% (yes, you read that right) of my daily recommended intake of vitamin A. So, even if I'm only going to absorb half of that because I'm not eating oily salad dressing, I think I can be assured that I'm getting more than enough of my vitamin A daily.

If you're worried about getting enough fat with your salad, sprinkle some flax meal or chia seeds on top of it!

Esselstyn: You can never "overdose" on the fat-soluble vitamins, like vitamin A, if you are getting them from real food. The body only takes what it needs from food. But, if you are getting your vitamin A from a supplement you can put yourself at risk for taking in too much.

Number Three Reader Question: How can you get enough omega-3s if you aren't eating fish?

Esselstyn: All omega-3s come from plants, originally. Fish make their omega-3s by eating microscopic green plants--phytoplankton. If you are eating farmed fish (like farmed salmon or tilapia) fed on grain, they aren't going to have any omega-3s. If you're eating all your green leafy vegetables (along with legumes & berries) you'll be getting enough omega-3s. Add in some daily flax meal, and you'll definitely get enough.

Me: The best way to get "enough" omega-3s is to drastically lower your intake of inflammation-causing omega-6s found in most oils, animal products, and many nuts (walnuts excepted). Americans have a sky-high omega-6 to omega-3 ratio of 17:1. We need it to be at best, 1:1 or at least, 4:1. It doesn't help to load up on omega-3 supplements if you aren't lowering your consumption of omega-6s.

My kitchen lab is open & I'm on a wild recipe roll--having a fun time taking my old-time favorite recipes and seeing if I can cut out the fat--and keep the taste in. So far so good. Of course, I kind of know which ones are going to work before I even start.

I love chocolate pudding!!! But my Jello Sugar-Free Cooking Chocolate Pudding is now history.

When we were vacationing in Maine with our kids, my grandson was getting a little "irregular". I had brought along a recipe for a single serving of "Chia Pudding" so we decided to see if he would like it, and if it would "move him along".

For those new to Chia, it gets a pleasant gelatinous covering when it's immersed in a liquid. So, when you mix it up with a little hazelnut milk, some vanilla, & a sweetener like agave, you get a vanilla tapioca pudding in about 20 minutes. Read all about Chia here.

By the way, the gorgeous grandson loved his chia pudding--and felt just great when it cured him of his "irregularity"

So...last night I decided to open my kitchen lab, and test out Chocolate Chia Pudding.

1/3 to 1/2 cup "nut milk" I like hazelnut, but almond or soy should work just fine. I used 1/2 a cup.

1 to 2 tsp. sweetener like agave, or maple syrup. I used one packet of stevia--the equivalent of 2 tsp. of sugar. You could try 1/2 a packet.

1 Tablespoon of unsweetened, non-Dutched cocoa.

Heat up a couple of tablespoons of the milk in the microwave--because it's impossible to mix up cocoa in cold milk. Mix the cocoa up into the hot milk to form a nice smooth paste. Add the rest of the cold milk slowly, mixing well.

Add the chia seeds and sweetener and stir well, making sure to submerge the chia.

Allow it to sit 20-30 minutes, but stir once more after 5 minutes to prevent chia-clumping.

Stir again before serving.

Makes one delicious serving. Next time I'm going to double the recipe.

Comments

Did you ever try doing something with the pureed pumpkin and chia pudding? If so how did it go?
Inspired by "I heart Trader Joe's" cookbook, I bought a bunch of cans of organic pumpkin from TJ's as a seasonal item that the author stockpiles and now I'm wondering what the heck to do with it. . .
Also I prescribe Chia to patients all the time and new ways to use it is great. I'm testing out chia fresca on myself this week.

help...confused...have read both esselstyn and ornish and am on whole food, plant based diet. think i understand that the body only needs approx 14 grams of total fat per day and i am only taking in 15 to 20 (10% to cal.) but ornish charts suggest i need 28 to 30 for my body wt. and exercise. i can't get that much fat off a plant based diet w/o adding high fat plants (soy,etc) and i prefer not to do that. Is there a minimum amt. of fat below which there are problems???

Dr. Esselstyn doesn't aim for any minimum, as far as I know--just no added oils, no nuts, no seed, no soy (except the light variety)--I think on his plan one would be getting something like 9-12% fat--and all his patient are thriving.

I started the Esselstyn diet last week.It was hell until today.Irritable etc.I always watch what I eat and have fish five days a week,chicken once.Never fried obviously.No breads at all.My cholesterol numbers are excellent however two Heart Cam CT's should five areas of plaque.
Now I am trying this and today seems fine.My wife made me a vegetable soup with basil and garlic.Added some whole grain brown rice and it really tastes great.
I still have my red wine every day.
I was wondering why Esseltyn eliminates fish from the diet.Does anyone know?
I have a pond that has delicious Bass with no mercury.
Gene

Thank you so much for your great recipes and this informative blog. I have a question about almond milk. I'm enjoying using the plain unsweetened on my cereal, but I'm a little confused as to why we can drink almond milk but we cannot eat nuts. Doesn't almond milk contain a concentrated amount of almonds/almond oil? Should I limit the amount I use per day?

I am a new vegan (about three months), eating a no oil, plant-based diet with lots of greens, fruits and a few whole grains. My question is about dha versus ala. The dha form of omega-3, which is animal based, is said by many to be necessary for optimal human health. Even the best algae-based omega-3 supplements are still the ala form. I stopped taking fish oil at the beginning of this diet because I noticed my fish oil capsules had 75 mg. of cholesterol, and the reason I began all of this was to lower my cholesterol. Now I'm wondering if I should take the fish oil after all. The experts all conflict with each other.